CMS’ “Qualified Entity” Certification Gives HCCI Opportunity to
Track and Report on Medicare Provider Care Costs and Quality in All 50
States

July 08, 2014 12:01 AM Eastern Daylight Time

WASHINGTON--(BUSINESS WIRE)--The Health Care Cost Institute (HCCI) announced today that the Centers
for Medicare & Medicaid Services (CMS) has certified HCCI as the first
national “Qualified Entity” (QE), making it the first
organization to have full access to national Medicare claims data for
reporting on the costs and quality of health care services. Having
access to the national CMS cost data set will enable HCCI to build on
its robust commercial health plan data set and offer the most
comprehensive information available about the price and quality of
health care services.

Created as part of the Affordable Care Act, the Qualified
Entity Program permits select organizations to combine Medicare
Parts A, B, and D claims data from CMS with other payer data to evaluate
the performance of providers, services, and suppliers in the health care
sector, among other things. As a Qualified Entity, HCCI will have access
to 100 percent of the nation’s traditional Medicare claims data and
about 40 percent of Medicare Part D prescription drug claims data. HCCI
also currently holds data on roughly 40 percent of the Medicare Part C
(managed care) population.

HCCI currently holds one of the largest private health insurance claims
databases available for public reporting and academic research purposes.
The addition of comprehensive Medicare claims data will now afford HCCI
a unique and unprecedented opportunity to track and publicly report on
health care trends using both public and commercial data. Moreover, HCCI
intends to convert its access to the Medicare data to a research license
to pursue a broad research agenda using the combined dataset containing
information on more than 100 million individuals.

“The national Medicare cost data set will be a powerful addition to the
HCCI transparency initiative, providing essential information to help us
better understand what is needed to improve the quality and performance
of the U.S. health system,” said David Newman, executive director of
HCCI. “Public reporting, as permitted with these data, when combined
with cost and quality data from commercial health plans and state
Medicaid data will represent the most credible information source for
consumers, regulators and employers on health care cost and quality
variation.”

Health care costs have been rising more than three times as fast as
wages. Official estimates project that U.S. health spending will reach
$4.7 trillion by the end of the decade - an 80 percent increase from
$2.6 trillion in 2010 - underlining the need to better understand the
prices of health care services to help make decisions and choices about
purchasing care.

The independent, not for profit HCCI announced in May that it will
create and administer an information portal that will provide consumers,
employers and regulators free access to consistent, comprehensive
information about the price and quality of health care. Aetna, Humana,
and UnitedHealthcare have agreed to provide information on health care
costs to HCCI, which will maintain and manage access to the information
in a highly secure, protected environment. Other participating
commercial insurers will be announced soon. The new online tool is
expected to be available in early 2015.

Other major commercial carriers have expressed interest and HCCI expects
additional carriers to participate in the near future and be part of the
initial release in early 2015. The cost data will be supplemented with
quality and other information to provide consumers a transparent and
comprehensive destination to make more informed decisions about health
care.

About the Health Care Cost Institute

The Health Care Cost Institute was launched in 2011 supported by Aetna,
Humana, Kaiser Permanente and UnitedHealthcare to promote independent,
nonpartisan research and analysis on the causes of the rise in U.S.
health spending. HCCI believes an improved understanding of the forces
driving health care cost growth will help policy makers, researchers,
and the public make decisions that will lead to better and more
accessible and affordable care. HCCI is governed by a board
that includes distinguished economists, actuaries and health care
experts.For more information, visit www.healthcostinstitute.org
or follow us on Twitter @HealthCostInst.